Lotfi. MH., Aminian. AH., Ghomizadea. A., et al.

Brief Report

A Study on Psychological Health of First Year University Students in Iran

Mohammad Hassan Lotfi, PhD •* , Amir Houssain Aminian, Msc ** ,

Aghdasea Ghomizadea, Msc ** , Forough Noorani, MD **
(Received: 22 December 2008 ; Accepted: 5 August 2009)

Objective: Psychological status of university students has an important role in their

academic performance. The present study was planned to evaluate the psychological view of
new entrance students of Shaheed Sadoughi University of Medical Sciences.
Methods: General Health Questionnaire (GHQ-28) was used to collect data from 1689
students who visited the Advisory and Guidance Center of the University.
Results: Subjects consisted of 512 (30.3%) males and 1174 (69.7%) females. Overall,
35.7% of students showed a GHQ score of ≥23, of those 8.1% had GHQ>40. More female
students showed a GHQ score above the cutoff point of 23 (p=0.003). The highest and lowest
GHQ scores were seen in nursing students (40.8%) and students of health faculties (32.2%)
(p=0.03).
Conclusion: More than one-third of freshmen had GHQ score of ≥23. Female students and
students of nursing and midwifery faculty were particularly at higher risk of developing mental
health problems.
Iranian Journal of Psychiatry and Behavioral Sciences (IJPBS), Volume 3, Number 2, Autumn/Winter 2009: 47-51.

Keywords: General Health Questionnaire (GHQ-28) • Medical Students •

Psychological Health

achievement (3,4). In recent years, there is a

1
Introduction growing appreciation of the stresses involved
in medical training. Studies have classified the

P sychological status of university

freshmen has an important role in their
learning ability and academic
performance. It seems that, fierce competitions
in the general entrance exam and an obligation
to succeed especially for high-ranking
specialist programs along with family
expectation may continuously affect the
psychological status of high school students
before and after admission to universities (1-
3). Too much stress can cause physical and
mental health problems, reduce students’ self-
esteem and may affect students academic
Authors' affiliations : * Department of Biostatistics and
Epidemiology, Shaheed Sadoughi University of Medical Sciences,
** Shaheed Sadoughi University of Medical Sciences.
•Corresponding author : Mohammad Hassan Lotfi, Assistant
Professor of Biostatistics, Epidemiology department, Health
Faculty, Shaheed Sadoughi University of Medical Sciences,
Daneshju Blv. Yazd, Islamic Republic of Iran.
Tel: +98 351 6245853
E-mail: m_h_lotfi@yahoo.com
sources of stress into three main areas:
academic pressure, social issues, and financial
problems (3,5). In a 5-year prospective
longitudinal cohort study by Guthrie et al,
(1998) students were assessed in years 1, 4,
and 5 of their medical undergraduate training
by means of the GHQ-12. One hundred and
seventy two (84.3%), 157 (77.0%) and 155
(75.9%) students out of an original group of
204 completed assessments in years 1, 4, and
5, respectively. Eighteen students were above
threshold point of GHQ-12 in all three
occasions, 25 in two occasions and 43 in one
occasion; 69 students were never a 'case'.
Students who were suffering from disorder in
two or higher occasions gave history of a
stressful first year of medical education (6).
Blanco and his colleagues, who have studied
mental health of college students, concluded
that “urgent action” is needed to improve
detection and early treatment in this group (7).

47 Iranian Journal of Psychiatry and Behavioral Sciences (IJPBS), Volume 3, Number 2, Autumn/Winter 2009
 Psychological Health of Students

The present study was planned to evaluate the Results

psychological view of new entrance students
of Shaheed Sadoughi University of Medical A total of 1686 respondents completed the
Sciences using cumulated data for three years. GHQ-28 in the survey. Subjects were 512
It is expected that recognizing students with (30.3%) males and 1174 (69.7%) female with
high scores of GHQ, and relevant correlations median age of 19 years. About seven and half
can prepare directors of advisory and guidance percent of them were married. Overall, 35.7%
center of university to run a prevention of students showed a GHQ score of ≥23, of
strategy to decrease the incidence of severe those 8.1% scored above 40. Twenty nine
psychological problems such as depression, point six percent of males and 38.4% of
anxiety, obsessive disorders, etc. amongst the females obtained the different levels of GHQ
students. scores (≥23) with a statistically significant
difference (p=0.003). More discrepancy
Materials and Methods between males and females was observed at
the level of GHQ>40, where number of female
In a cross-sectional study, researchers students was approximately twice of males
collected data from all freshmen of Shaheed (9.1% vs. 5.7%) (Table1). Higher GHQ scores
Sadoughi University of Medical science by were observed in students who had come from
administering General Health Questionnaire- other cities and counties rather than from
28 (GHQ-28) for three years (2005-2008) locality (p=0.02).
(n=1689). All freshmen, who had started the
University program in the last month, were Table 1. Frequency distribution of GHQ-28 levels
in students according to sex*
invited to the Advisory Center and completed
the GHQ-28 after an interview. GHQ-28 sex Male Female Total
includes 28 items, which assesses somatic GHQ score
symptoms, anxiety and insomnia, social <23 360(70. 3) 722 (61.5) 1082 (64.3)
23-30 70 (13.6) 204 (17.4) 274 (16.2)
dysfunction, and severe depression. Each item 31-40 53 (10.3) 141 (12) 194 (11.5)
is accompanied by four possible responses, >40 29(5.8) 107 (9.1) 136 (8)
typically being ‘not at all’, ‘no more than total 512 (100) 1174 (100) 1686 (100)
usual’, ‘rather more than usual’, and ‘much *p.value =0.003
more than usual’, scoring from 0 to 3,
According to table 2, married and
respectively. Total possible score on the GHQ-
unmarried students showed no significant
28 ranges from 0 to 84 and allows for means
difference in various levels of GHQ score
and distributions to be calculated, both for the (p>0.05), but comparison of mean score of
global scale, as well as for the four sub-scales. anxiety and sleeping disorders showed that,
A sensitivity of 89.5%, a specificity of 82% married students had significantly higher
and a repeatability of 84% for the Persian scores than unmarried ones (p=0.003).
version of the test have also been reported
(8,9). A cutoff point of ≥23 was considered for Table 2. Frequency Distribution of GHQ-28 Levels
doubtful abnormality of psychology where in Students According to Marital Status*
those having score of higher than 23 were
followed for more screening and surveillance Marital Status Unmarried Married Total
programs. Data were analyzed by SPSS GHQ-28
<23 992 (64.2) 90 (64.4) 1082 (64.3)
software using descriptive statistics such as
23-30 237 (15.3) 21`(15) 258 (16.2)
frequency tables, means (±SD), median and
31-40 169 (11) 17(12) 186 (11.5)
non-parametric statistical testes such as chi- >40 148 (9.5) 12 (8.6) 160 (8.1)
square, Mann Whitney and Kruskall Wallis Total 1546 (100) 140 (100) 1686 (100)
tests. A significance level of 5% was *P.Value >0.05
considered for statistical analysis.

Iranian Journal of Psychiatry and Behavioral Sciences (IJPBS), Volume 3, Number 2, Autumn/Winter 2009 48
Lotfi. MH., Aminian. AH., Ghomizadea. A., et al.

Although there was no statistically Discussion

significant correlation between different levels
of GHQ score and various academic programs,
MSc and MD students, compared to other
students, had higher GHQ scores (31-40 and
>40) (Table 3). The high GHQ score was
generally found to be associated with
significantly higher mean score of social
dysfunction (p=0.009).
Mental disorders have been found to be
common all over the world. According to a
WHO report, about 50 million individuals are
suffering from psychological disorders with a
higher proportion in the developing countries
(10). Prevalence of mental health problems in
Iran is between 11.7%-43.2% (10).

Table 3. Frequency distribution of GHQ-28 levels in students according to educational course*

Level MSc and MD Bachelor High Diploma Total

GHQ-28
<23 183 (61.6)
23-30 48 (16.2)
31-40 40 (13.5)
>40 26 (8.8)
Total 297 (100)
*p.value >0 .05
A significant association between field of
study and GHQ score was seen, where the
highest percentage of GHQ scores of ≥23
belonged to nursing and midwifery students
(40.7%) and the lowest one was related to
health-care students (32.3%) (p=0.03).
Moreover, it was noted that higher percentages
of GHQ scores of >40 was observed in
students of medicine and dentistry (Table 4).
More analysis showed that compared to others,
students of nursing and midwifery, medicine
and dentistry had significantly higher mean
scores of somatic symptoms and social
dysfunction respectively (p=0.001 and
p=0.001, respectively).
381(63.5) 518 (65.6) 1082 (64.1)
109(18.2) 116 (14.6) 273 (16.2)
65(10.8) 88 (11.1) 193 (11.4)
44(7.3) 68 (8.6) 138 (8.2)
599 (100) 790 (100) 1686 (100)
In present study, authors found that 35.7%
of freshmen showed evidence of mental health
problems. This is different from what has been
seen in simlar studies carried out in other parts
of Iran. Prevalence of mental disorders in
freshmen of Bam, Gonabad, and Tehran
medical schools were 25.1%, 41%, and 16.5%
respectively (11-13). These figures, in two
other studies in Shaheed Beheshti University
(in Tehran) were 12.5% (2000) and 30.4 %
(2001) (14). Being under stress to pass
National University entrance examination,
entering a new environment, living far away
from family and therefore lack of emotional
support and undesirable dormitory conditions
can increase GHQ-28 score at the beginning of
students academic life (8,15,16). Research has
also shown that completing GHQ individually
in comparison to answering it within a group

Table 4. Frequency distribution of GHQ-28 levels in students according to university fields*

Course Medicine and Nursing and

Paramedical Health Total
Dentistry Midwifery
n (%) n (%) n (%)
n (%) n (%)
GHQ-28
<23 183 (61.6) 167 (59.2) 225 (62.6) 507 (67.8) 1082 (64.1)
23-30 48 (16.2) 50 (17.7) 65 (18.2) 109 (14.6) 272 (16.1)
31-40 40 (13.5) 44 (15.6) 39 (10.8) 71 (9.5) 194 (11.5)
>40 26 (8.8) 21 (7.4) 30 (8.4) 61 (8.1) 138 (8.2)
Total 297 (100) 282 (100) 359 (100) 748 (100) 1686 (100)

*p.value= 0.03

49 Iranian Journal of Psychiatry and Behavioral Sciences (IJPBS), Volume 3, Number 2, Autumn/Winter 2009

and the site of completing the GHQ
(classroom or consultation room) could affect
the GHQ-28 score (17,18).
In our study, a significant association
between sex and high GHQ score was seen,
where the proportion of female students
suspected to have mental disorder (%38.4) was
considerably higher than male students
(%29.5). This is similar to the findings of other
studies (19-21).
No significant relationship between marital
status and GHQ levels was seen, but mean
score of anxiety and sleeping disorder showed
that, married students were significantly at
higher risk. In two separate studies carried out
by Tavakolizadeh and Yaghoobi et al, it was
identified that, mental health of married
students was better than single students
(12,21). We can only hypothesize that in our
study population marriage and accompanying
economical or relationship problems at such a
young age could have been a risk factor for
developing anxiety and sleep disorders.
In our study, similar to Bagheri et al’s study
(13), and contrary to Kafee et al’s study (19),
the rate of mental disorder was lower in local
students. Entering a new environment, lack of
family support, exposure to a different culture,
and financial difficulties are possibly the main
stressors (13,17,22). Our results also showed
high GHQ psychological and somatic scores in
nursing and midwifery students in comparison
to GHO scores in students of other programs.
This was higher in females than males
possibly because of their disappointment of
not being accepted to study medicine (23).
Students of medicine and dentistry had higher
GHQ scores (>40) and a significantly higher
mean score of social dysfunction probably
because they experienced high level of stress
to be able to pass a highly competitive
entrance examination.
In conclusion, our study revealed that the
rate of mental health problems was higher
among female students, non-locals and
students of nursing and midwifery as well as
medicine and dentistry. These results call for
development of prophylactic measures, early
detection and management of common mental
health problems among students to improve
their quality of life and academic performance.
Iranian Journal of Psychiatry and Behavioral Sciences (IJPBS), Volume 3, Number 2, Autumn/Winter 2009
Psychological Health of Students
Recommendations:
The authors, therefore, ask for an expansion
of consultation centers and development of
welfare and cultural facilities for freshmen
especially for those who live in dormitories
and away from their families. Preparing
students, well before starting University,
especially in the colleges and high schools
through input from an educational
psychologist will also help them to develop
appropriate social skills to be able to cope
better against various stressors and fit well into
their new role.
References
1. Fish C, Nies MA. Health promotion needs
of students in a college environment. Public
Health Nurs 1996; 13(2):104-11.
2. Chew-Graham CA, Rogers A, Yassin N. 'I
wouldn't want it on my CV or their
records': medical students' experiences of
help-seeking for mental health problems.
Med Educ 2003; 37(10):873-80.
3. Sreeramareddy CT, Shankar PR, Binu VS,
Mukhopadhyay C, Ray B, Menezes RG.
Psychological morbidity, sources of stress
and coping strategies among undergraduate
medical students of Nepal. BMC Med Educ
2007; 7: 26.
4. Silver HK, Glicken AD. Medical student
abuse: incidence, severity, and significance.
JAMA 1990; 263(4):527-32.
5. Vitaliano PP, Russo J, Carr JE, Heerwagen
JH. Medical school pressures and their
relationship to anxiety. J Nerv Ment Dis
1984; 172(12):730-6.
6. Guthrie E, Black D, Bagalkote H, Shaw C,
Campbell M, Creed F. Psychological stress
and burnout in medical students: a five-year
prospective longitudinal study. J R Soc
Med 1998; 91(5):237-43.
7. Blanco C, Okuda M, Wright C, Hasin DS,
Grant BF, Liu Sh, et al. Mental Health of
college students and their non–college-
attending peers. Arch Gen Psychiatry 2008;
65(12):1429-37.
8. Goldberg DP, Gater R, Sartorius N, Ustun
TB, Piccinelli M, Gureje O, et al. The
validity of two versions of the GHQ in the
WHO study of mental illness in general
50
Lotfi. MH., Aminian. AH., Ghomizadea. A., et al.
health care. Psychol Med 1997; 27(1):191-
7.
9. Humman A. [To evaluate of repeatability
and validity of GHQ-28 questionnaire
(Persian version) prepared by Goldberg.]
[Dissertation]. Tarbiat Moalem University
of Teharan; 1997. Persian.
10. WHO international consortium in
psychiatric epidemiology. Cross-national
comparisons of the prevalence and
correlates of mental disorders. Bulletin of
the World Health Organization; 2000.
11. Soleimanizadeh L, Soleimanizadeh F,
Bagheri Yazdi A, Borhani F, Abbas zadeh
A, Javadi M. [Evaluation of mental health
in university centers of Bam in 2004].Teb
va Tazkie 2007: 14(2-1):26-31. Persian.
12. Tavakkolizade J. [Prevalence of
psychological symptoms in students of
Gonabad medical school] .Teb va Tazkie
2001:43:35-8. Persian.
13. Bagheri A. [Evaluation of mental health in
entering students of Tehran university in
1991-95]. Andishe and Rafter 1991:4:11-
16. Persian.
14. Bahreinian SA, Broomand M GH.
[Evaluation of mental health in dormitory
students of Shaheed Beheshti University].
Pajoohesh dar Pezeshki 2002:26(3):240.
Persian.
15. Ziaee V. [Evaluation of mental health in
Tehran University during 1994-99 based on
SCLR-90 and comparison to interview].
Teb va Tazkie 2001:43:15-8. Persian.
16. Asadi SM, Shegarf Nakhee MR. [Aspects
of mental health in three race of medical
51 Iranian Journal of Psychiatry and Behavioral Sciences (IJPBS), Volume 3, Number 2, Autumn/Winter 2009
students]. Conference of Mental Health in
Medical Students 2004:2:67-9.
17. Nishimura R. Study of the measurement of
defense style using Bonds defense style
Questionnaire. Psychiatry Clin Neurosci
1995:52(4):419-24.
18. Ansari A, Ghani M. [Evaluation of
psychological disorder in Mashhad
Medicine School.] [Dissertation]. Mashhad
University of Medical Siences;1997.
Persian.
19. Kafee SM, Bolhari J, Peiravi H.
[Evaluation of educational status and
mental health of Tehran University students
entering in 1993-94]. Published in
Consultation Department of Tehran
University; 1994. Persian.
20. Akashe Gh. [Evaluation of mental health
students entering in 1996]. Andisheh va
Raftar 1996: 4:4-11. Persian.
21.Yaghoobi H. [Evaluation of mental health
students in Guilan University (1996-97)].
Guilan Medicine University Journal 1999:
27(28):40-7. Persian.
22. Busfield J. The archaeology of psychiatric
disorders of thought, emotion and behavior.
In: Bendelow G, Carpenter M, Vautier C,
Williams S. Gender Health and Healing.
London: Routledge Butler; 2002. p.144-62.
23. Momen Nasab M, Farhadi A. [Effect of
University education on mental health of
new entering students in Lorestan (1998-
99)]. Teb va Tazkie 2001; Suppl 1:3-8.
Persian.